SUPERIOR COURT OF WASHINGTON
COUNTY OF ______
JUVENILE COURT / No:
Dependency of:
D.O.B.: / Notice and Summons/Order:
Dependency
Termination of Parent-Child Relationship
(NTSM)

State of Washington To:

Name:______

Address:______

______

I. Notice of Hearing

1.1You are notified that a petition, a copy of which is provided, was filed with this court alleging that:

Dependency: the abovenamed child is dependent. A Dependency Petition begins a judicial process which, if the court finds the child dependent, could result in substantial restriction or permanent loss of your parental rights.

Termination of Parent-Child Relationship: the abovenamed child is dependent and a permanent termination of the parent-child relationship should occur. A termination Petition, if granted, will result in permanent loss of your parental rights.

Notice: If your child is placed in out-of-home care, you may be held responsible for the support of the child.

1.2The court has scheduled a fact-finding hearing on:

______(date) at: ______AMPM,

At: ______, Room/Department: ______

Address: ______

1.3The purpose of the hearing is to hear and consider evidence relating to the petition. You should be present at this hearing.

1.4If you do not appear the court may enter an order in your absence:

Establishing dependency.

Permanently terminating your parental rights.

II. Summons

You are summoned and required to appear at the hearing on the date, time, and place set forth above.

III. Advice of Rights

  • You have important legal rights, and you must take steps to protect your interest.
  • You have the right to a fact-finding hearing before a judge. At the hearing, you have the right to speak on your own behalf, to introduce evidence, to examine witnesses, and to receive a decision based solely on the evidence presented to the judge. You should attend this hearing.
  • You have the right to be represented by a lawyer. If you cannot afford a lawyer you have the right to request that the court appoint a lawyer to represent you at public expense. If you qualify, a lawyer will be appointed by the court to represent you.
  • Your lawyer can look at the social and legal files in your case, talk to the supervising agency or other agencies, tell you about the law, help you understand your rights and help you at hearings.
  • If you wish to have a lawyer appointed, contact ______[Name].

Address:______

______

Phone:______

You may call (Name) for more information about your child. The agency’s name and telephone numbers are:

Address:______

______

Phone:______

IV. Order to Appear
You are ordered and required as the parent, guardian or custodian having custody and control of the child to bring the child to the above fact-finding hearing.
Notice: Violation of this Order to Appear is subject to a proceeding for Contempt of Court Pursuant to RCW 13.34.070.
Dated:
Judge/Commissioner

Dated: Issued by Petitioner:

DSHS/Supervising Agency

By (name)

Signature

Print name WSBA #

(Name) ______

Signature

Print name WSBA #

Nt & Summons/Or (Dep/Guard/Term) (NTSM) - Page 1 of 2

WPF JU 03.0200 (06/2016) - JuCR 3.4; RCW 13.34.070, .080, .180, .230